Provider Demographics
NPI:1457337693
Name:LANE, ELIZABETH (OGNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:OGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 LENDEW ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7007
Mailing Address - Country:US
Mailing Address - Phone:336-273-2835
Mailing Address - Fax:336-273-1948
Practice Address - Street 1:1908 LENDEW ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7007
Practice Address - Country:US
Practice Address - Phone:336-273-2835
Practice Address - Fax:336-273-1948
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC800039207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2591601Medicare ID - Type Unspecified
NCS91211Medicare UPIN